Acupuncture

Acupuncture refers to a method of inserting thin, sterile, solid needles into specific sites on the body. Its myriad applications span analgesia to treatment of organ dysfunction, neurologic abnormalities, myofascial restriction, immune disorders, and many other conditions. Although most think of needles when they hear the term, acupuncture actually incorporates an array of interventions intended to either augment the needle's effects or obviate the need for needling altogether. Such interventions include electrical stimulation (ie, electroacupuncture); moxibustion (in which a smoldering herb heats the acupuncture point or embedded needle); low level laser stimulation (laser-puncture); pressing techniques (acupressure); and injection of vitamins, saline, or other solutions into sites (aquapuncture).

Practitioners of “traditional Chinese medicine” (TCM) adhere to principles developed in prescientific times, replete with mistaken interpretations about organ functions and suffused with metaphors such as “wind invasion” and “spleen damp heat” instead of modern medical knowledge.

While the roots of Chinese medicine can be traced as far back as the Han dynasty (206 BCE to 220 CE) or earlier, the field of TCM as adopted by many veterinarians is recent. TCM was updated and compiled by order of Chairman Mao Tse Tung in the mid-twentieth century. Confronted with widespread epidemics and too few Western-trained physicians, Mao sought a a revised and simplified compilation of Chinese medical theories that would help address the public health needs of the ailing masses. He also eventually found it helpful to promote quintessentially Chinese approaches as a matter of national pride. Subsequently, he marketed TCM to Western doctors. An unfortunate mixing of western metaphysics with TCM transformed acupuncture into a pseudoscientific “energy medicine” practice that disavows science and its true underlying actions of neuromodulation and connective tissue effects. Making matters worse, TCM practitioners cling to dubious diagnostic techniques such as tongue diagnosis and pulse diagnosis. No research supports the validity or reliability of these techniques, even for people for whom these practices were developed.

Fortunately, decades of scientific research on its mechanisms and indications now make it possible to practice acupuncture and related techniques without metaphors or belief systems. Patients receive diagnoses based on modern medical methods and informed palpation. Needling is regarded as a means of afferent stimulation that engenders modulation of central, peripheral, and autonomic nervous system function, as well as signal initiation and transfer among associated connective tissue structures. Objective outcomes can be measured and assessed through scientific research, as results from rigorous, controlled trials lend further sophistication and insights into treatment plans and physiologic outcomes, respectively.

Mechanisms of Action

The belief among TCM practitioners that acupuncture works by moving invisible energies began with a mistranslation of the Chinese word “qi” into energy in the 1930s. A French bankteller working in China, Georges Soulié de Morant, strongly believed that “energies” formed the basis of healing. For lack of a better word, Soulié de Morant translated the term "qi" into "energy." Thus began the misplaced notion in the West that acupuncture moved "energy." In reality, the term "qi" referred to dissolved gases and nutrients that circulated throughout the vascular system. Given that acupuncture was originally a blood-letting technique, this explains the correspondence between acupuncture channels and blood vessels. Over time, as needles became thinner and more refined, acupuncturists ceased bleeding patients. By the 1950s, Chinese scientists began accepting that the effects they found in patients occurred as a result of the nerves being stimulated near the former blood vessel targets. Today, the term "neuromodulation" has been accepted by scientific acupuncturists around the world as explaining the basis for acupuncture's effects.

Research findings from physiologic studies show that acupuncture needles, or other devices, affect afferent nerve fibers in the skin, subcutaneous tissue, fascia, muscle, tendons, vascular walls, or periosteum, purportedly eliciting local or peripheral reflexes that have beneficial effects on the body.

Several explanations exist for how acupuncture reduces pain. Some assert that acupuncture interrupts nociceptive transmission at the level of the spinal cord, producing spinal segmental analgesia, or that acupuncture alters the processing and perception of pain centrally. Others have suggested that any pain-relieving effects may be more simply attributed to placebo effects, distraction, a diffuse noxious stimulus, or psychologic alteration of the perception of pain. Various neurotransmitter and neuroendocrine responses have been associated with acupuncture. Specific parameters important for optimal effects in acupuncture are emerging as research defines how treatment design impacts clinical outcomes. For example, targeting specific dermatomes corresponding to local pathology rather than remote sites leads to greater improvements in pain control, physical activity, and sleep quality. Frequency and duration of stimulus also influence the analgesic response. Mounting evidence reveals a multiplicity of mechanisms and clinical benefits from acupuncture. Research is expanding regarding the clinically relevant benefits that acupuncture confers on many problems, including those of inflammatory, musculoskeletal, neuropathic, neoplastic, or visceral origin.

Contraindications

Acupuncture has a strong safety profile, and few contraindications exist. Although pregnancy is often considered a contraindication, based on concern that acupuncture might affect hormone levels or uterine innervation, evidence of serious adverse effects is lacking, even in late pregnancy. Coagulopathies or immune compromise might represent contraindications if needling leads to excessive bleeding or local infection, respectively.

Acupuncture may be contraindicated if an animal cannot remain still enough to perform needling safely. High levels of anxiety, fear, or aggression could counteract health-promoting autonomic changes generated by acupuncture. In such cases, efforts to calm the animal may be warranted.

Some TCM-based acupuncture practitioners may claim that cancer is a contraindication for acupuncture, although no evidence exists to support their claims that unseen energies emanate from the point into the tumor and incite growth. The belief that acupuncture will encourage cancer metastasis because it can augment circulation is similarly unfounded; however, there is also no proof that acupuncture itself fights cancer.

Adverse Effects

Acupuncture provided by medically educated professionals such as veterinarians results in few adverse effects and is generally considered safe. The risks of invading a major organ or vessel with a needle are limited as long as the practitioner remains aware of the patient's anatomy. Extreme negative reactions to a needle may indicate that it has entered a nerve; in those cases, the needle should be withdrawn. Handlers of horses have been injured when horses have kicked during acupuncture treatment. Needle ingestion by the patient appears to constitute the most frequent concern in animals, although there are no published reports of injury. Adverse reactions that have been reported in people include fainting, skin infections, and hepatitis; such reactions have not been reported in animals.

Controversies

The fundamental tenets of energy-based acupuncture remain unproved. No evidence indicates that invisible meridians or qi energies exist. Due to the limited number of clinical studies in acupuncture for veterinary patients and the current disavowal of the scientific basis of acupuncture by TCM practitioners, acupuncture has not been recognized as a specialty by the American Board of Veterinary Specialties.

Gold bead implantation, the process of intentionally inserting small bits of metal into the body as a type of “permanent acupuncture,” resembles a Japanese technique in which acupuncturists buried acupuncture needles into tissue and cut them off at the surface, leaving a lifelong implant.

The medical literature contains cases in which acupuncture needle fragments or implants have migrated to the spinal cord, peritoneal cavity, heart, stomach, liver, breast, brain, bladder, kidney, and colon. In animals, radiographic evidence has shown that implants can migrate long distances, eg, from the hip to the thoracolumbar region or abdominal wall. Embedding ferromagnetic objects in tissue may compromise the quality of computerized scans such as CT and MRI, causing artifacts and obscuring diagnoses. So far, no studies of gold bead implantation justify the risks of migration and artifact-laden imaging studies.